View NSCB Procedures View NSCB Procedures

11.6.3 Protecting Children from the Harmful Effects of Second-hand Smoke (Prospective Foster Carers and Prospective Adopters)

SCOPE OF THIS CHAPTER

This chapter details the approach taken when prospective foster carers or adopters are smokers or when dealing with existing foster carers or adopters who smoke. It contains information on support available including the role of the social worker. It also deals with children and young people who smoke although this section is mainly relevant for foster carers.

RELEVANT LEGISLATION AND GUIDANCE

  • Fostering Services (England) Regulations 2011;
  • Fostering Services National Minimum Standards (2011), Standards 6 and 10;
  • Adoption Agencies Regulations 2005;
  • Adoption and Children Act 2002 Guidance (2011), Chapter 3;
  • Adoption National Minimum Standards (2011) Standards 5 and 9;
  • BAAF practice note 30: Children and smoking;
  • BAAF practice note 51: Reducing the risks of environmental tobacco smoke for Looked After Children and their carers.

AMENDMENT

In January 2016, Appendix B: Copy of Leaflet 'Smoking advice for prospective foster carers and adopters' was updated.


Contents

  1. Introduction 
  2. Context  
  3. Policy  
  4. Enquiries and Applications from People who Smoke
  5. Current Carers or Prospective Adopters who Smoke 
  6. Support for Carers or Prospective Adopters who wish to Stop Smoking
  7. E-cigarettes
  8. Children and Young People who Smoke 
  9. The Role of social workers

    Appendix A: Smoking Questionnaire 

    Appendix B: Copy of Leaflet 'Smoking advice for prospective foster carers and adopters'

    Appendix C: Smoking Agreement

    Appendix D: Copy of Fostering Network Position Statement on Smoking and the use of E-cigarettes

    Appendix E: Copy of ASH Foster Care Briefing Paper


1. Introduction

Children and Young People Services acting as the corporate parent for Looked After Children has a duty to promote the health and well-being of those children. Many come into the care system with impaired or neglected health as a result of their previous experiences. It is important to place them with carers who will be able to promote their health and model a healthy lifestyle.

Children are particularly vulnerable to the effects of second-hand smoke because:

  • They are often unable to remove themselves from a smoky home environment because of their age;
  • If children are younger or have a disability, they are likely to spend most of their time in close proximity to a carer or parent;
  • The lungs, airways and immune systems of young children are not fully developed and are therefore more susceptible;
  • Their respiratory rate is higher than an adult's so they breathe in more harmful chemicals, per pound of body weight, than an adult would in the same period of time.

The Fostering and Adoption Services are committed to following a shared policy on the placement of children in smoking households, to ensure that no Looked After Child will be placed with a smoking family unless exceptional circumstances apply. This means not only following a consistent approach when receiving enquiries from potential foster carers or adopters, but also having an agreed position in terms of existing foster carers and prospective adopters who are smokers.


2. Context

The National Minimum Standards for Fostering Services (England) 2011 emphasise the importance of health promotion awareness for foster carers both in relation to their own health and that of the children in their care.

Adoption agencies are unable to impose "blanket" bans when considering applications from prospective adopters. Nevertheless, it is essential that smoking should be discussed with enquirers and that they should be made aware of the implications of smoking for their own health and that of a child.

Enquirers for both fostering and adoption should be made aware of the limitations that smoking will place on them, particularly in terms of the age of child they might be considered for, but also in relation to certain health needs or disabilities.


3. Policy

The Fostering and Adoption Services are committed to ensuring that no Looked After Child, and particularly a child under 5 years, are placed within a smoking household unless exceptional circumstances apply. Not only will this improve the health of children, but it will also protect agencies from potential legal action in the future.

"Exceptional circumstances" refers to a situation where the child's other identified needs are well met and there is no alternative family available. A decision to place a child in a smoking household must be ratified by the relevant Children's Service Manager/Group Head.

The Fostering or Adoption Panel will need to see evidence that the Smoking Agreement has been signed (see Appendix C: Smoking Agreement ) and have confidence that the family will honour the terms contained therein.

Children with respiratory or cardiac conditions, middle ear problems or a disability such as Down's syndrome or Cystic Fibrosis will not be placed with a smoking family unless there are exceptional circumstances.

All older children, who are able to express a view, must be given a choice to be placed with a non-smoking family wherever possible

Enquirers for both Fostering and Adoption will be sent a leaflet about smoking in the information pack and will be encouraged to consider seeking support via their GP or a smoking cessation programme to stop smoking.

The Declaration of Health used by both Fostering and Adoption includes a smoking questionnaire to seek information about the smoking behaviour of the applicants, other household members and regular visitors to the home.

Foster carers and prospective adopters who stop smoking (e.g. in order to be able to consider younger children) will only be regarded as "non-smokers" once they have not smoked for 12 months. This is because relapse rates are high within the first three to six months; lower after six months, but significantly reduced after 12 months.

At enquiry stage all prospective foster carers and adopters will be provided with a copy of a leaflet entitled 'Top Fire Safety Tips'. This will be discussed as part of the health and safety check.

Foster carers will complete an annual Declaration of Health (including the smoking questionnaire) and their smoking habits will be considered at their annual review of registration.

The Smoking Agreement will be incorporated into the Foster Carer Agreement, which is signed annually.

Where prospective adopters have an annual review of approval, health issues (including smoking) will form a part of this.

Children and young people who smoke will be given information about the health risks associated with this and encouraged to access support to stop smoking.

social workers also act as role models for children and young people in care. They should therefore, carefully consider the importance of promoting non-smoking and the positive messages that they convey to young people.


4. Enquiries and Applications from People who Smoke

All enquirers who contact the Fostering and Adoption Services should be welcomed and treated with courtesy and respect. If, in the course of the initial contact, it becomes clear that the enquirer is a smoker, they should be made aware of the existence of a smoking policy. They should also be informed that:

  • A leaflet about smoking is included in the information pack sent to all enquirers;
  • A smoking questionnaire forms part of the Declaration of Health (see Appendix A: Smoking Questionnaire);
  • If their application is accepted, they will be required to sign a Smoking Agreement if they are unable or unwilling to stop smoking, or another household member or regular visitor to their home is a smoker.

It should be made clear to enquirers that although smoking will not automatically bar them from making an application, it may seriously restrict the resource they are able to offer. In particular they will not normally be considered for children under 5 years or children with certain health needs or disabilities. In addition, children who come from non-smoking birth families and children who express a wish to be placed in a non-smoking household will not be placed with them, as far as this is possible to achieve.

An information pack will be sent to enquirers. The inclusion of a smoking leaflet entitled 'Smoking advice for prospective foster carers and adopters' (see Appendix B) in every pack avoids discrimination and also covers situations where enquirers themselves may not be smokers, but other members of the household, or regular visitors to their home do smoke.

The initial visit to potential foster carers or adopters should include a discussion about smoking.

The social worker and manager will need to make a decision about whether or not to invite the enquirer to make a formal application. Whilst a number of factors will be considered, the enquirer's attitude towards smoking and their willingness to address this will be one important element.

Assessment process

As part of the assessment, smoking habits will be addressed, along with other health issues.

Where applicants for fostering or adoption are smokers who are unable or unwilling to stop smoking, or where other members of their household or regular visitors to their home are smokers, the Smoking Agreement must be discussed with them during the assessment process. The agreement should be signed before the application is taken to Fostering or Adoption Panel, and a copy made available to the Panel hearing the application.

When proposing a placement, the supervising (fostering) social worker or adoption social worker should revisit the health and safety check undertaken during the assessment to ensure that any work or changes identified have been implemented.


5. Current Carers or Prospective Adopters who Smoke

The Smoking Agreement will be incorporated into the Foster Carer Agreement, which is signed annually.

Foster carers complete a Declaration of Health each year as part of their annual review of registration. Any changes in smoking behaviour or health should be considered at the review.

Prospective adopters have an annual review up to the point where a child is placed with them. Any changes in their health (including smoking) will form part of this review. Adoption medicals are also updated every two years.


6. Support for Carers or Prospective Adopters who wish to Stop Smoking

Please refer to Appendix B: Copy of Leaflet 'Smoking advice for prospective foster carers and adopters'.


7. E-cigarettes

The use of electronic cigarettes (e-cigarettes) is a relatively new development but is a growing phenomenon. These are battery operated devices that provide a nicotine delivery system which does not contain tobacco. The most recent evidence suggests that they are effective in helping people to stop smoking, and that they are unlikely to be taken up by those who are non-smokers.

Electronic cigarettes produce a vapour, but there is no evidence to date that second hand vapour is harmful to human health. E-cigarettes play a role in reducing tobacco smoking levels nationally, and they could be a useful aid to foster carers who may wish to use them to cut down or stop tobacco smoking. The use of e-cigarettes imitates smoking behaviour by mimicking the sensation and appearance of smoking a cigarette for the user and for those around them. There are some concerns that this may ‘normalise’ smoking behaviour, making it more acceptable especially to children and young people.

Whilst current research evidence suggests that the use of electronic cigarettes is effective in helping people to stop using traditional tobacco cigarettes, there is little to suggest that it is encouraging smoking. The Fostering and Adoption services are therefore following The Fostering Network’s guidance,  which  considers the current research evidence provides no compelling reasons for restricting the use of e-cigarettes. Therefore foster carers should not be prevented from fostering or applying to foster because of their use of e-cigarettes.

However we advise it is good practice not to use them in front of children and young people until more evidence is gained about the role modelling effect of this on the smoking behaviour of children more generally. We endorse the content of the briefing paper produced by ASH (Action on Smoking and Health) and the Fostering Network (July 2014) Foster Care, adoption and electronic cigarettes which gives a comprehensive overview of the topic and is an aid to policy development.

In addition, as a general rule we will not place children under 5 years old with carers who use E-cigarettes.

Please refer to:

Appendix D: Copy of Fostering Network Position Statement on Smoking and the use of E-cigarettes

Appendix E: Copy of ASH Foster Care Briefing Paper


8. Children and Young People who Smoke 

This section is mainly relevant to foster care, given that children placed for adoption are usually younger and are unlikely to have started smoking. However, on the rare occasions that an older child who smokes is placed for adoption, the following guidance would equally apply.

Where children are already smokers every effort should be made by carers, in liaison with health professionals, to ensure that they are fully aware of the health risks associated with smoking. Carers should be equipped by the agency to offer appropriate advice to children and young people who smoke. The aim should always be to discourage smoking.

Carers must never buy cigarettes for children and young people in their care, and cigarettes must never be used as a reward for good behaviour.

Carers' household rules should include expectations about smoking and these should be made clear to young people on placement.


9. The Role of social workers

Social workers also act as role models for children and young people in care. They should therefore, carefully consider the importance of promoting non-smoking and the positive messages that they convey to young people.

They should support carers in ensuring that young people have access to information and services to help them to stop smoking.

social workers must never smoke in the presence of, or in view of, children and young people or buy cigarettes for them.

They should not smoke in a car which will be used later to transport a child or young person.

They should not smoke outside case conferences or reviews.


Appendix A: Smoking Questionnaire

Click here for Appendix A: Smoking Questionnaire


Appendix B: Copy of Leaflet 'Smoking advice for prospective foster carers and adopters'

Smoking evokes strong feelings in both smokers and non-smokers alike.

Although there is a Government ban on smoking in public places, smoking in the home will continue to have a significant impact on the health of smoking and non-smoking members of the household. Children are particularly vulnerable and the Local Authority, acting as the corporate parents for children in our care, has a duty to promote every aspect of their welfare, including their health. People who apply to be foster carers or adoptive parents should be fully aware of:

  • The risks associated with smoking;
  • The position of the Local Authority; and
  • The implications for any application to be considered as a carer for children, whether temporary or permanent.

Some facts about smoking:

  • Tobacco smoke contains a mixture of around 4000 chemicals, many of which are poisonous and cause cancer and heart disease;
  • Second-hand smoke is even more toxic than the smoke which goes directly into the smoker's lungs;
  • If you're breathing second-hand smoke at home or work, your chances of developing asthma are doubled, your risk of developing lung cancer is increased by 24% and the risk of heart disease is increased by 25%;
  • Children who live with smokers are much more likely to become smokers themselves.

Our position on smoking:

We are committed to reducing the level of smoking in the county and protecting non-smokers from the damaging effects of second-hand smoke. One important aspect of this is to encourage and support smokers who want to give up and to promote local "stop smoking" services.

What are the main concerns in relation to fostering and adoption?

  1. Carers who smoke are damaging their own health and potentially compromising their ability to actively parent the child. This is of particular concern for a limited number of foster carers and all adopters who are providing a permanent home for the child. Children who have experienced many losses in their lives may be faced with the premature loss of another parent figure as a result of smoking related disease, disability or death;
  2. Carers who smoke are damaging the health of children in their care. Babies and children who are exposed to a smoky atmosphere are:
    • Twice as likely to have asthma attacks and chest infections;
    • More likely to need hospital care in the first year of life;
    • Off sick from school more often;
    • More likely to get more coughs, colds and wheezes;
    • At greater risk of getting "glue ear", which can lead to deafness.
  3. Adult carers act as role models for their children. Children who live with smokers are much more likely to become smokers themselves, with all the health risks that this poses. Smoking is a difficult habit to break, so it is important to encourage children never to start.

What if I only smoke at work/in the car/outside/in another room?

You might think that smoking at work - if you're still allowed to do it! - deals with the second-hand smoking issue. However, the smoke on your clothes that you take back into the home still contains poisonous chemicals which can affect the health of those who breathe it in. The same is true if you smoke in the car, outside or in another room. It is impossible to cancel out the damaging effect of smoke which hangs around on your clothes, or drifts into the house or another room and, of course, in all these situations the risk to your own health is still present.

So should I stop smoking to foster or adopt?

Ideally, yes - for your own health's sake and for the welfare of the child who would be placed with you. We will raise this with you at the outset and hope that you will be open with us about your smoking. Government statistics suggest that 70% of smokers wish to give up. If you're one of them, we can point you in the direction of services which might help you achieve this. Your GP is the first port of call. Most people find that it is quite difficult to simply stop smoking, and many are more successful if they have some support and encouragement.

If you are unable to stop smoking or have no wish to stop, this will not mean an automatic ban on becoming foster carers or adopters. We look at many factors, health and other wise.

Realistically, however, smoking will restrict the number of children we could consider placing with you. Because of this we would need to decide whether we were justified in taking up an application from you. Our focus must be on the child and we are legally obliged to make them our first and foremost consideration.

Medical advice is that children under 5 years should not be placed within a smoking household, nor should children who have:

  • Asthma or other breathing difficulties;
  • Heart conditions;
  • Middle ear/glue ear problems;
  • A disability such as Down's Syndrome or Cystic Fibrosis;
  • Been born prematurely;
  • A family history of asthma.

From these examples, you can see that if you are committed to fostering or adoption you would be well advised to first commit yourself to stop smoking. Generally speaking, medical advisers expect to see that applicants have not smoked for at least twelve months before they consider them to be "non-smokers".

How to get help to stop smoking:

If you want to stop smoking it is important that you first seek advice from your GP who will be able to discuss how you might approach this and also give you information about local support groups.

You may also find the following phonelines and websites helpful:

  • NHS Smoking Helpline  
    0300 123 1044 (freephone);
  • www.nhs.uk/smokefree;
  • NHS Asian Tobacco Helpline
    0800 169 0 881 (Urdu)
    0800 169 0 882 (Punjabi)
    0800 169 0 883 (Hindi)
    0800 169 0 884 (Gujarati)
    0800 169 0 885 (Bengali);
  • Text GIVE UP with your full postcode to: 88088.

NHS "Stop Smoking" Services across Nottinghamshire:

FREE support for smokers who want to stop.

  • Bassetlaw Stop Smoking Service
    "Do you want to kick the habit?"
    0800 328 8553 or 07968 016256
  • New Leaf Stop Smoking Service
    (covers Ashfield, Mansfield, Newark and Sherwood. This service offers FREE nicotine replacement therapy to those registered with GPs in this area)
    0800 389 7712
    Text LEAF to 80800
  • Nottingham New Leaf City Stop Smoking Service
    (covers Nottingham City, Gedling, Rushcliffe, Broxtowe and Hucknall)
    0800 561 2121
    Text NEW to 80800


Appendix C: Smoking Agreement

Click here for Appendix C: Smoking Agreement


Appendix D: Copy of Fostering Network Position Statement on Smoking and the use of E-cigarettes

Click here for Appendix D: Copy of Fostering Network Position Statement on Smoking and the use of E-cigarettes


Appendix E: Copy of ASH Foster Care Briefing Paper

Click here for Appendix E: Copy of ASH Foster Care Briefing Paper

End